Case Study

Perinatal and Postpartum Depression: Screening and Detection

“It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects.”
American College of Obstetricians and Gynecologists (ACOG), 2018

Two weeks ago, Destiny discovered she is pregnant by using a drugstore test. She begins to cry as she provides this information during her Texas Health Steps preventive medical checkup. You make a note to confirm Destiny’s pregnancy through a blood test, then sit at eye level with her and listen with empathy as she tearfully explains her situation.

“My boyfriend used a condom, but maybe not every time,” she says. “I know I should be excited but I feel sad and overwhelmed most of time. I’m afraid I will lose my job. I haven’t been able to sleep. I don’t want to eat. Is it normal that I feel like crying so much?”

Destiny’s poor appetite and sleep, as well as her emotional lows, may be temporary symptoms associated with pregnancy. However, they also could be indications of depression. Your actions and guidance—and ability to listen—are crucial to help Destiny maintain stable emotional health.

Note: An estimated 14 to 23 percent of women experience depression during pregnancy. Studies of low-income mothers and pregnant and parenting teenagers have reported rates of depressive symptoms at 40 to 60 percent, a far higher rate than that of other mothers.

Patient: Destiny
Sex: Female
Age: 19 years

Click below to learn more about four ways you should respond to Destiny's symptoms.

Screen for depression.

It is crucial to determine whether Destiny has depression, because that mood disorder can impact her health during pregnancy as well as the health of her baby. Untreated depression during pregnancy can result in miscarriage, premature birth or a low birth weight baby. Pregnant women with depression who don’t receive treatment may miss out on prenatal care, or fail to get proper nutrition and rest.

The Texas Health Steps Periodicity Schedule provides a guide to adolescent mental health screening and screening tools.

Prepare to refer.

If Destiny’s screening results indicate the likelihood of depression, refer her to a qualified Medicaid-enrolled mental health specialist for diagnosis and treatment. Screening alone can have clinical benefits, according to AGOG, but initiation of treatment or referral to mental health care providers offers maximum benefit. Systems should be in place to ensure follow-up for diagnosis and treatment.

Share patient resources.

Support Destiny and guide her to the Texas Department of State Health Services’ Healthy Texas Babies web page and other resources about self-care during pregnancy, emotional wellness, coping skills, and support groups. Have the “Depression During and After Pregnancy” brochure from the U.S. Department of Health and Human Services for patients like Destiny.

Be alert for postpartum depression.

If Destiny is diagnosed with depression, she will be at increased risk for postpartum depression (PPD). ACOG estimates that about one mother in seven (about 14 percent) experiences PPD, but certain populations may have higher rates.

Texas law allows Texas Health Steps providers to be separately reimbursed once for conducting maternal postpartum depression screening during a Texas Health Steps preventive medical checkup up to an infant’s first birthday. The Texas Health Steps Periodicity Schedule provides a guide to PPD screening and screening tools.

Why It Matters

Primary care providers have a critical role in promoting maternal health and reducing maternal morbidity and mortality. Early recognition and intervention can make a substantial difference in the mental health of women who may be pregnant and, in turn, make a difference for their babies. Learn more by enrolling in the Related Courses shown below.

Integrating Postpartum Depression Screening into Routine Infant Medical Checkups

Maternal and child health are intricately linked. This tutorial explores the impact of postpartum depression and provides guidance about how Texas Health Steps providers can receive separate reimbursement for conducting maternal postpartum depression screening during an infant’s regular checkup.

About Texas Health Steps

Texas Health Steps’ award-winning online program offers FREE CE courses for primary care providers and other health professionals. These courses offer updated clinical, regulatory, and best practice guidelines for a range of preventive health, oral health, mental health, and case management topics.